The professional fee for anaesthesia care is separate to fees charged by the surgeon, hospital or other healthcare providers. The fee is calculated according to the Australian Society of Anaesthetist’s (ASA) Relative Value Guide, which allocates a number of ‘units’ to an anaesthetic episode of care. The number of units varies according to the operation, complexity, duration, timing, patient co-morbidities and provision of ancillary services for care.
The total anaesthetic fee has three components:
- The Medicare rebate (75% of the schedule fee)
- The private health fund component
- The patient’s contribution (the out-of-pocket or ‘gap’ payment)
Out-of-pocket payments have arisen as rebates from Medicare and private health funds have not been indexed with regards to medical practice costs (staff, rent, utilities, indemnity insurance) nor inflation. The ASA and Australian Medical Association (AMA) provide a comprehensive, indexed list of services and associated fees. Each anaesthetist sets the total fee independently, often at a discount to the recommendations from the ASA and AMA.
Private health insurance arrangements can be complex, may depend on individual level of cover and there can be significant variation between insurers, particularly with “known gap” arrangements. In particular, members of Frank, Latrobe Health Services, Mildura Health Fund, St Luke’s Health and NIB will receive the Medicare rebate, however the health fund component can be substantially lower, resulting in higher out-of-pocket payments.
Estimates of the total professional fee will usually be issued prior to surgery. Please contact your health fund to confirm your level of cover and expected rebate. Please contact EMA on 03 9116 5551 prior to your procedure to address any questions.
For more details regarding professional fees for anaesthesia care click here.